摘要
目的老年2型糖尿病肾脏病患者甲状腺激素与肌少症的相关因素分析。方法收集2018年6月—2023年6月在复旦大学附属华东医院住院的≥60岁2型糖尿病肾脏病患者共200例(男性97例,女性103例)。进行一般情况测定(包括身高、体重、腰臀比等),检测肝肾功能、糖化血红蛋白、尿微量白蛋白、甲状腺功能等实验室检查,以及6 m步速,电子握力计测量惯用手握力,生物电阻抗法进行身体成分检测。卡方检验进行率的比较,Logistic回归进行相关性分析。结果(1)本研究人群中,肌量下降、握力下降、步速下降的比例分别为22.3%、44.0%、67.5%,肌少症的患病率为15.6%。(2)以游离三碘甲状腺原氨酸(free triiodothyronine,FT3)4.0 pmol/L为切点,将患者分为FT3低值组和FT3高值组,FT3低值组肌少症比例高于FT3高值组(23.5%vs 8.2%),差异有统计学意义(χ^(2)=7.733,P=0.005)。(3)以总三碘甲状腺原氨酸(total triiodothyronine,TT3)1.2 nmol/L为切点分为TT3低值组和TT3高值组,TT3低值组步速下降的比例高于TT3高值组(76.9%vs 57.6%),差异有统计学意义(χ^(2)=7.065,P=0.008)。TT3低值组握力下降的比例高于TT3高值组(51.3%vs 35.9%),差异有统计学意义(χ^(2)=4.092,P=0.043)。(4)以促甲状腺激素(thyroid stimulating hormone,TSH)水平1.5 mIU/L为切点分成低TSH组和高TSH组,低TSH组握力下降的比例低于高TSH组(34.1%vs 50.5%),差异有统计学意义(χ^(2)=5.128,P=0.024)。(5)Logistic回归分析显示,低FT3水平的糖尿病肾脏病患者发生肌少症的风险增加(OR=0.369,95%CI:0.153~0.889);低TT3水平患者步行速度减慢(OR=0.448,95%CI:0.221~0.911)。结论住院老年DKD患者肌肉含量下降和肌肉力量下降检出率高,部分甲状腺激素指标与肌少症密切相关,低FT3水平是老年DKD患者肌少症的独立相关因素。
Objective To investigate the correlation between thyroid hormone and sarcopenia in elderly patients with type 2 diabetic nephropathy.Methods A total of 200 patients(97 males and 103 females)aged≥60 years old with type 2 diabetic nephropathy who were admitted to Huadong Hospital Affiliated to Fudan University from June 2018 to June 2023 were collected.Their general condition(including height,weight,waist-to-hip ratio,etc.)and laboratory indicators such as liver and kidney function,glycated hemoglobin,urinary microalbumin,thyroid function,and 6-meter walking speed were measured.Their dominant hand grip strength was measured by electronic grip dynamometer and body composition was measured by biological impedance method.Chi-square test was used to compare the rates and logistic regression was used to analyze the correlation.Results(1)In this study population,the proportion of muscle mass decline,grip strength decline and pace decline were 22.3%,44.0%and 67.5%,respectively,and the prevalence rate of sarcopenia was 15.6%.(2)Taking free triiodothyronine(FT3)4.0 pmol/L as the cut-off point,patients were divided into FT3 low value group and FT3 high value group.The proportion of sarcopenia in the FT3 low value group was higher than that in the FT3 high value group(23.5%vs 8.2%),and the difference was statistically significant(χ^(2)=7.733,P=0.005).(3)Taking total triiodothyronine(TT3)1.2 nmol/L as the cut-off point,the patients were divided into TT3 low value group and TT3 high value group.The proportion of pace decline in the TT3 low value group was higher than that in the TT3 high value group(76.9%vs 57.6%),and the difference was statistically significant(χ^(2)=7.065,P=0.008);the proportion of grip strength decline in the low TT3 group was higher than that in the high TT3 group(51.3%vs 35.9%),and the difference was statistically significant(χ^(2)=4.092,P=0.043).(4)Taking thyroid stimulating hormone(TSH)1.5 mIU/L as the cut-off point,the patients were divided into low TSH group and high TSH group.The proportion of grip strength decrease in the low TSH group was lower than that in the high TSH group(34.1%vs 50.5%),and the difference was statistically significant(χ^(2)=5.128,P=0.024).(5)Logistic regression analysis showed that diabetic nephropathy patients with low FT3 levels had an increased risk of developing sarcopenia(OR=0.369,95%CI:0.153-0.889);patients with low TT3 level had slower walking speed(OR=0.448,95%CI:0.221-0.911).Conclusion The detection rate of decreased muscle content and muscle strength in hospitalized elderly patients with diabetic nephropathy is high.Some thyroid hormone indexes are closely related to sarcopenia,and low FT3 level is an independent correlation factor for sarcopenia in elderly patients with diabetic nephropathy.
作者
凯丽比努尔·麦麦提吐孙
邱婕萸真
杨巧凤
徐媛媛
黄宇新
陶晓明
蒋翠萍
Kailibinuer Maimaititusun;Qiu jieyuzhen;Yang Qiaofeng;Xu Yuanyuan;Huang Yuxin;Tao Xiaoming;Jiang Cuiping(Department of Endocrinology,Huadong Hospital Affiliated to Fudan University,Shanghai,200040,P.R.China;Department of Endocrinology and Metabolism,Second People's Hospital of Kashgar Prefecture,Kashgar,Xinjiang,844000,P.R.China;Caojiadu Street Community Health Service Center,Jing'an,Shanghai,200041,P.R.China)
出处
《老年医学与保健》
CAS
2024年第3期813-818,共6页
Geriatrics & Health Care
基金
上海市科委国内合作课题(21015801300)
静安区医学科研课题(2023SQ03)。
